Clark David, Ingleton Christine, Hughes Philippa, Yap Tom, Noble Bill
International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, LA1 4YT, UK.
Support Care Cancer. 2004 Oct;12(10):683-91. doi: 10.1007/s00520-004-0673-7.
Since the early 1990s, the United Kingdom has seen several initiatives designed to improve the quality of cancer palliative care in the community. We report on the evaluation of a project that took place in the rural county of Powys in Wales in which a group of general practitioner clinical facilitators (GPCFs) sought to raise the overall standard of palliative care among primary health care teams (PHCTs). The evaluation was conducted over 3 years and made use of several methods: interviews with facilitators and other key stakeholders at regular intervals throughout the project; a survey of PHCT members at two time points; an analysis of patterns of opioid prescribing in the county before and during the project; monitoring of referrals to specialist palliative care services out of county; and an analysis of place of death of those dying from cancer. The evaluation found that local general practitioners (GPs) were willing to work as facilitators and that they made contact with over two thirds of those in the PHCTs. Facilitators undertook a variety of clinical, educational and service development initiatives but did report on problems of role definition and time management. There were no marked changes in patterns of referral to specialist palliative care or in place of death, but there was some evidence to suggest that the facilitators had an influence on their colleagues' opioid prescribing patterns.
自20世纪90年代初以来，英国开展了多项旨在提高社区癌症姑息治疗质量的举措。我们报告了在威尔士波伊斯郡农村开展的一个项目的评估情况，在该项目中，一组全科医生临床协调员（GPCFs）试图提高初级卫生保健团队（PHCTs）的姑息治疗总体水平。评估历时3年，采用了多种方法：在项目期间定期与协调员及其他关键利益相关者进行访谈；在两个时间点对PHCT成员进行调查；分析项目前后该郡阿片类药物处方模式；监测转诊至郡外专科姑息治疗服务的情况；以及分析癌症死亡者的死亡地点。评估发现，当地全科医生愿意担任协调员，并且他们与超过三分之二的PHCT成员取得了联系。协调员开展了各种临床、教育和服务发展举措，但确实报告了角色定义和时间管理方面的问题。转诊至专科姑息治疗的模式或死亡地点没有明显变化，但有一些证据表明协调员对其同事的阿片类药物处方模式产生了影响。
